Objective : To demonstrate the use of multiple large local flaps in the reconstruction of large scalp defects.

Methods : A review of 3 cases with diabetes in which the “banana peel” method of scalp reconstruction, originally described by Orticochea, was used as a technique for closure of moderately large to extensive scalp defects.

Results : In all 3 cases closure of the scalp defects was accomplished at first intention. These are secondary to scalp necrosis after incomplete avulsion in one case and for the others due to malignant tumour resection. Morbidity has affected the donor site with the lost of the skin graft in one patient. Secondary healing was obtained by means of Davis skin grafting procedure.

Conclusion : While other techniques may be optimal for the treatment of most scalp defects, such as one to two rotation advancement flaps in small to moderate-size lack of substance and microvascular free tissue transfer and secondary tissue expansion for larger defects. We conclude that the use of multiple local flaps may be a simple solution in a small subset of patients. The latter includes older severely debilitated patients who would be optimally treated with microvascular free flaps but could not tolerate lengthy general anaesthesia. In addition diabetes in our patients with the underlying microangiopathy may seriously affect the outcome in case of long procedures.